# PENTECOSTAL TEMPLE RESIDENTIAL SERVICES, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902999568
- **Authorized official:** MRS. CHRISTINA SIMS-SMITH BS, QP (CLINICAL DIRECTOR)
- **Authorized official phone:** (252) 752-6951

## Contact information

- **Practice address:** 2753 W 5TH ST, GREENVILLE, NC 27834-7817
- **Practice address phone:** (252) 752-0057
- **Practice address fax:** (252) 830-4094
- **Mailing address:** PO BOX 983, GREENVILLE, NC 27835-0983
- **Mailing address phone:** (252) 752-0057
- **Mailing address fax:** (252) 830-4094

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | MHL-115 | NC | Yes |

## Other

- **Enumeration date:** 10/02/2006
- **Last updated:** 08/22/2020